Rheumatoid Arthritis of the Hand and Wrist

What it is

Rheumatoid arthritis (RA) is an inflammatory disease that affects the whole body. Inflammation breaks down joint cartilage, stretches the ligaments that stabilize joints, and can weaken or rupture tendons. It usually affects the wrists and finger joints on both sides of the body.

Symptoms

• Stiff, swollen, painful joints, often on both hands
• Sausage-shaped swollen fingers
• A soft lump on the back of the hand that moves with the fingers
• Fingers drifting toward the small finger
• Clicking or catching of the fingers, or numbness and tingling
• Sudden inability to straighten or bend a finger, which can mean a tendon has ruptured
• Finger deformities such as boutonniere or swan-neck

Diagnosis

A full examination, X-rays that may show joint narrowing or bone erosion, and blood tests for inflammation and RA-specific markers.

Treatment

RA is mainly treated with medication, often disease-modifying drugs prescribed by a rheumatologist. These are powerful at protecting joints but act on the immune system, so they need careful monitoring. A steroid injection can calm a flare in one or a few joints. Surgery is needed less often than in the past. It may help when a joint is painful, stiff, or deformed despite medication, or when a tendon ruptures, and can fuse or replace a joint or repair a tendon. Your rheumatologist and hand surgeon work together to decide if and when surgery makes sense.